The following article appeared in the Los Angeles Times on January 2, 2012:


By Anna Gorman, Los Angeles Times

January 2, 2012

Soon after America Bracho started a health nonprofit in Santa Ana 18 years ago, a student in her diabetes self-management class needed eye screening. He didn’t have enough money to pay for it, so Bracho and the class decided to raise the funds — by selling tamales.

The man had the screening, and Bracho had a new motto: We will build a healthy community, even if we have to sell tamales.That motto now guides Bracho, a Venezuelan-born doctor, in her work as president and chief executive of Latino Health Access, an organization with a roughly $3-million budget dedicated to disease prevention and health promotion in underserved communities of Orange County. The organization still holds an annual “tamalada” to raise money for its diabetes patients and its programs, which include breast cancer awareness, domestic violence counseling and exercise classes.
Bracho sees firsthand the health problems facing Latinos, many of whom are uninsured and fighting chronic diseases such as diabetes and hypertension. But like an increasing number of public health officials, Bracho doesn’t believe medical care is the primary solution. She said education, prevention and most importantly, participation can have a bigger effect on communities such as Santa Ana.Adapting a model she saw in Venezuela, Bracho, 54, has trained thousands of promotoras, or community workers, to teach their neighbors and friends how to be more healthful — in businesses, homes and schools. Many are diabetics or domestic violence victims who came seeking help themselves.Promotoras don’t need medical degrees, she said. All they need is the desire to get involved.

“If you are a single mom on this street in Santa Ana and your kids don’t have any place to play, you should be in that conversation to assure your voice is heard,” she said.

Their voices are being heard — and so is Bracho’s.

“There are three women in my life who tell me what to do: my mother, my wife and America Bracho,” said Dr. Robert K. Ross, president of the California Endowment, a prominent statewide health nonprofit that helps fund the organization’s work.

Among the guests at the recent tamale fundraiser were the Mexican consul for Santa Ana, local politicians, and executives from St. Joseph’s Hospital in Orange and the California HealthCare Foundation.

But Bracho’s work on behalf of Spanish-speaking, uninsured and often illegal immigrants isn’t always welcomed in heavily conservative Orange County.

She recently clashed with the county Board of Supervisors about a mental health contract. The supervisors questioned her use of the Spanish word promotora and why the word “Latino” was in the organization’s name if it was supposed to be helping residents throughout the county.

“I didn’t know what promotora meant,” Supervisor John M.W. Moorlach said. “How is someone who doesn’t speak Spanish supposed to know that when this is supposed to be available to everyone?”

Raised by two teachers in Caracas, Bracho said her family was relatively well-off but poverty was all around her.

As a young doctor, Bracho treated patients with malariatuberculosis and diarrhea. There, she met her first community health workers. “They were my coaches, they were my inspiration, they were my instructors,” she said.

Although she loved treating patients, she recognized that her impact was limited as a small-town doctor. So she got a master’s degree in public health in Michigan. She got a job working on HIV programs for Latinos in Detroit, and she immediately recruited community workers, many of whom were HIV positive, sex workers and former drug users.

After a few years, she moved to Orange County to host a health show on a Spanish-language radio station. She started the nonprofit in 1993.

Now, working with promotoras throughout Orange County, Bracho said she “sees things right when they appear…. You know before the newspaper what happens in this community.”

Bracho, who stands just over five feet, dresses in colorful tops and is almost always moving. Speaking quickly and with her hands, she switches easily from English to Spanish.

Santa Ana doesn’t fit the profile of affluent Orange County. One-fifth of residents in the city live in poverty. Public health officials said the city has the highest rate of uninsured children and adults in the county and the most crowded living conditions. The city has the highest percentage of avoidable emergency room visits, along with high rates of asthmaheart diseaseobesity and diabetes.

The California Endowment chose central Santa Ana last year as one of 14 underserved areas across the state to take part in a $1-billion program to focus on building healthy communities.

Latino Health Access has more than 60 employees and hundreds more volunteers.

Mario Marin, 55, learned about the organization 10 years ago after becoming a diabetic. He took free classes on how to manage the disease and soon began teaching them.

Before long, he had given up his job at a Carls Jr. and was working for Bracho’s organization full time. Marin said his life is completely different from what it used to be, when he drank regularly, smoked and ate unhealthfully. “I have much experience to share,” he said.

Just this month, the organization broke ground on a park and community center in Santa Ana. The project came to be after several parents in the community spoke out about the lack of places for their children to play. Latino Health Access got a $3.5-million grant from the state, and the city and a local businessman donated the land. “It will be like an oasis in a desert,” said Rosalia Pinon, one of the organizers.

During a recent training session for community health workers at a hospital in south Orange County, each of the participants said their name, their favorite food and their hobby.

That, Bracho told the group, is how promotoras connect with their community. They don’t develop relationships by asking about glucose readings, but rather by talking about what they have in common: favorite foods and hobbies.

And, she told them, promotoras must be open to learning from the people they are serving.

“Unlike a doctor or a lawyer, we help each other,” she said. “It’s reciprocal.”